As with a book, so with its author: where his readers locate him is where he finds himself. The book's career made me an authority on depression.
One unnerving development was my exposure to memoirs of mood disorder. The bedside table groaned under the weight of typescripts and bound galleys. There were accounts by sexually depleted depressives, promiscuous depressives, urban single mothers, small-town family men, femmes fatales, gay lotharios, celebrities, journalists, ministers, and psychologists. The collection represented an outpouring of autopathography such as no prior generation had known. I was asked to endorse these books, to review them, to vet them for publishing houses, to assess their worth in the midst of a bidding war.
A psychiatrist is pleasedoverjoyedto see a mental illness shed some of its stigma. But as a reader, I became ever less enthralled. Despite the superficial variety, the memoirs of depression struck me as distressingly uniform. Their constant theme, their justification, was confirmation of the new reality, that depression is a disease like any other. The authors' self-exposure was an act of witness, converting former private shame into current openness about an unexceptional and unexceptionable handicap. This much was welcomea testimonial for the public health view of depression, often accompanied by advice to readers to seek evaluation and, if needed, treatment. But then more often than not, in these memoirs, hints of pride showed through, as if affliction with depression might after all be more enriching than, say, a painful and discouraging encounter with kidney failure. Expressions of value would emerge: Depression gave me my soul. The spiritual gift was not the insight that might arise in the face of any adversity. Despite their insistence on its ordinariness, the memoirs made depression seem ennobling.
I had admired the first handful of these books, not least for their courage. But the tenth confession is not so brave as the first. Soon I reached my limit. Awash in memoir, I told myself that I should complete the set. The memoir to end all memoirs. The final autopathography. A personal account of depression by someone who has never (this would be my claim) actually suffered the ailment.
If this project moved beyond the level of private joke, it was because depression had, in fact, perturbed me, as disease and suffering always perturb those who grapple with them. In my case, the point of confusion was this issue of romancethe glamour of depression. For the practicing psychiatrist, depression is grim enough.
It is true that among the major mental disorders, depression can have a deceptive lightness, especially in the early stages. Depending on the prevailing symptoms, the depressive may be able to laugh, support others, act responsibly. Depressed patients participate actively, even compulsively, in their own treatment. And depression, especially a first episode in a young adult, is likely to respond to almost any intervention: psychotherapy, medication, the passage of time. In my medical school days, if an inpatient psychiatry ward had spun out of control, a cagey chief would hold off on admissions until a good-prognosis depressive was referred. The hope was that the new arrival's recovery would restore morale, for staff and patients alike.
But the depression I dealt with in my practice had settled in to stay. The unrelenting darkness was a function of the length of my tenure here. I have seen patients in Providence, Rhode Island, for over twenty years. In a small practice, failure accumulates. As I wrote more, I let my clinical hours dwindle. The result was that patients who were not yet better filled many slots, along with those returning to treatment. And the popularity of Listening to Prozac meant that the loudest knocks on the office door were from families with a depressed member who had faltered elsewhere. Circumstance made me a specialist in unresponsive mood disorder. I worked amid chronic despair.
Excerpted from Against Depressionby Peter Kramer. Copyright 2005 by Peter Kramer. Reproduced by permission of Penguin Publishing. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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